Ready or Not, Here Come Bundled Payments

Tinker Ready, March 10, 2016

The mandatory shift to bundled payments for hip and knee replacements is a huge and complicated job for hospitals. "There is really no good blueprint" for it, says one surgeon. But it has to has to happen, and it and will.

In a few weeks, CMS will launch its long-planned mandatory program of bundled payments for hip and knee replacements. The goal is to "encourage hospitals, physicians, and post-acute care providers to work together to improve the quality and coordination of care from the initial hospitalization through recovery."

Sounds nice, unless it's you who has to actually implement all the pieces that must work together and the coordination of care. A new survey of more than 100 hospital orthopedic departments found that 56% reported feeling unprepared for the new program, and only 10% reported feeling fully prepared.

Ready or not, it's coming.

In reality, bundled payments have been a long time coming. After much discussion, the rule was proposed last summer. It was finalized in November, with a January start date that was later moved to April 1.

So, why aren't hospitals ready? Are they in denial or just overwhelmed? Or, are they chipping away at it while the plan is phased in?

The survey was conducted by Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement or FORCE-TJR, a clinical registry based at the University of Massachusetts Medical School. One of a group of registries collecting data in the US, it describes itself as an "independent, unbiased, expert data collection, analysis, and reporting system to guide best total joint replacement surgical practices."

It's no wonder that they've seen a surge of calls from hospitals interested in their services. That's what inspired the survey, said Patricia Franklin, MD, a UMass orthopedist and principal investigator for the FORCE-TJR registry project.

"It occurred to us that people are doing their homework now, so they are probably not prepared," she said. Hospitals need to know that "this is coming and it's coming fast."

Getting ready for such a change is a huge undertaking, Franklin says. UMass Medical School is not one of the nearly 800 hospitals that will be enrolled; it's already accepting bundled payments. But it signed on to participate voluntarily through the Bundled Payment for Care Improvement (BPCI) pilot initiative.

So, Franklin says she's seen all the work that goes into setting up one of these programs. Among other tasks, it requires hospitals to "amp up information systems to answer the cost and quality questions needed to manage well in this environment," she says.